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Report on 'Did Not Attend' Appointments at GP Surgeries In Report on ‘Did Not Attend’ Appointments at GP Surgeries in Goldthorpe Thurnscoe and Bolton upon Dearne Author: Lorna Lewis, Jade Bligh Surveyors: Lorna Lewis Jade Bligh Report Reviewed by: Healthwatch Champions, Healthwatch Strategic Advisory Board. Published August 2017 2 Healthwatch Barnsley DNA report – August 2017 Introduction About Healthwatch Barnsley Healthwatch Barnsley is commissioned by Barnsley Metropolitan Borough Council and hosted and managed by Voluntary Action Barnsley (VAB), Healthwatch Barnsley (HWB) is a community led, community driven organisation with a Strategic Advisory Board, responsible for determining the direction of the organisation. We are also assisted by volunteers (Healthwatch Champions) whose role is to gather information and prioritise areas of work, ensuring engagement with all sections of the local population. This enables us to be representatives of as many health and social care service users as possible. We are part of a national network of Healthwatch organisations that involve people of all ages and from all sections of the community in local health and social care services. We gather views from the community, report these views to the people responsible for providing and commissioning local services, engage people in decisions about services and monitor the service provision. As part of our work to gather views, we also can exercise our right to visit services through a process known as Enter and View. We also have a role in providing people with information about health and social care services available in the area. In some areas, Healthwatch organisations provide advocacy for people making a complaint about NHS services. In Barnsley, this service is provided by DIAL and their details are at the end of this report. DIAL is not limited to dealing just with health service complaints and can also look at problems with social care services. Through our partnership with DIAL, we have been able to successfully close a number of complaints from our clients regarding their experiences of local services. The national picture in relation to patients not attending appointments at their general practice Patients’ not attending appointments at their general practice is a major issue and cost to the National Health Service (NHS). DNA rates have an enormous impact on the health care system in terms of cost and waiting times, significantly adding to delays along the patient pathway. The financial cost of missed appointments in the NHS has been estimated, in 2015, at £300m per year, based on 14m appointments being missed per year1. By reducing the number of patients not attending appointments at general practices, even by a small amount, would result in a large financial saving. Reducing the rate of patients who did not attend their appointment (DNA) would also ensure that time was available for other 1 http://www.gponline.com/infographic-dnas-affect-general-practice/article/1352205 3 Healthwatch Barnsley DNA report – August 2017 patients who needed medical advice. This could then directly impact on the number of patients that present at A&E as they cannot get a GP appointment and are worried about their health, or get admitted to hospital due to their condition becoming serious. The impact of patient ‘Did Not Attend’ (DNA) appointments at GP surgeries in the Dearne In November 2015 an issue was brought to our attention by Councillor Gollick, on behalf of people living in the Dearne. The issue was that people were struggling to access their general practice. We reported on this issue in 2016. This report is a continuation of our outreach and engagement work in the Dearne area. Gathering views and feedback In order to gather more information and to speak to people living in the Dearne area, we arranged two engagement events at Goldthorpe and Thurnscoe Library. These events were publicised in the local press and via social media. As a result of this work, we spoke to a total of 42 people and found that the issue of people being able to get an appointment at their practice was a common theme. In order to find out what service providers thought about these access issues, we visited two surgeries in the Dearne and spoke to staff and the practice managers. At both surgeries staff raised the issue that the biggest problem affecting access to appointments was patients not attending appointments they had booked. In addition to our outreach and engagement work, we were called as a witness at the Overview and Scrutiny Commission led by Barnsley Council, as they had called a meeting to look at the local GP Federation and GP Access. At this meeting we were able to report on our findings to date and our plans for the next few months. Working with the ‘Dearne Approach’ The ‘Dearne Approach’ is a partnership of different organisations, including Barnsley Council, working to improve the area for the people living there. Access to GPs was one of the issues that residents had identified to the ‘Dearne Approach’ and we went to meetings to provide an update on our findings and to ask for support. We wanted help to raise awareness of the importance of people cancelling their appointments when they are unable to attend, to ensure that other people could benefit from seeing a medical professional. We informed the meeting that one practice reported that 350 patients did not attend their appointments in one quarter at an estimated cost of £10,850 (based on The King’s Fund’s presentation that suggested a ten minute appointement with a GP costs £312). Healthwatch Barnsley agreed to explore the issues relating to DNA’s with service users and General Practices across the Dearne. We also agreed to raise awareness about the importance of keeping appointments or cancelling appointments where necessary. 2 https://www.slideshare.net/kingsfund/making-the-case-for-public-health-interventions 4 Healthwatch Barnsley DNA report – August 2017 Gathering Information To gather more information we spoke to 350 patients living in Thurnscoe, Goldthorpe and Bolton upon Dearne. We also spoke to four general practices about DNA’s and the impact they have on their surgery. We used a survey (see appendix 1) when speaking to patients to ensure that we used a consistent approach and asked everyone the same question. During this work we wanted to focus on the following three areas: 1. How far in advance did patients have to wait for an appointment? 2. In the last six months have they booked an appointment at their GP practice but not attended. 3. If patients have tried to cancel an appointment but couldn’t and what prevented them. We spoke to people at events, local clubs and services; some of which are listed below: Salvation Army Goldthorpe Goldthorpe Library Willow Croft Flats, Bolton upon Dearne Snap Tin Café, Goldthorpe Willowcroft Flats, Bolton upon Dearne Rainbow Centre, Thurnscoe Thurnscoe Library St Helens Church, Thurnscoe Thurnscoe TARA Unity Club Goldthorpe Goldthorpe Centre We also spoke to people at four general practices covering Goldthorpe, Thurnscoe and Bolton upon Dearne. These included: Dearne Valley Group Practice Goldthorpe Medical Centre Lakeside Surgery Hollygreen Surgery In addition we gave each GP surgery a short questionnaire (see appendix 2). The questionnaire focused on gaining statistics on DNA’s from the surgeries. The information provided by the surgeries included the period November 2016 to May 2017. Validation of information received During the analysis process there were a number of responses which had to be withdrawn from the final data analysis due to the following reasons: 2 participants did not identify their GP practice in the survey. 3 participants were not registered at a GP surgery in the areas we were focusing on. 5 Healthwatch Barnsley DNA report – August 2017 The feedback received has been broken down into the location of the GP practice the patients accessed, rather than where the patients lived. Graphs to show the age range of the patients we spoke to and their gender can be seen below: Age range of patients 63 53 43 48 36 36 26 23 6 3 Gender of patients 222 110 5 Male Female Unknown 6 Healthwatch Barnsley DNA report – August 2017 Results from the patient survey In the last 6 months have you tried to book an appointment with your GP practice? 297 24 16 YES NO Unknown How far in advance did you have to wait for an appointment? 80 55 64 73 30 19 1 - 3 4 - 7 1 - 2 days days 2 - 3 weeks 4 - 5 weeks Other weeks (please specify) Our results show that just under 50% of patients can get an appointment within 2 weeks and just over 50% have to wait between 2 and 7 weeks. A GP online survey has shown that 7 Healthwatch Barnsley DNA report – August 2017 limiting the time that people have to wait for an appointment has help reduce the number of DNA’s. Other Comments (for a full list see appendix 3) A total of 178 patients left feedback on booking appointments, below are a few examples of the comments we received. Many patients were raising similar concerns about the difficulty they faced when booking an appointment. “I had to wait 4-5 weeks for an appointment, rang every day to get this. I have to ring out of hours. I have learning difficulties and depression that makes me more anxious.” “Difficulty getting in to see a doctor, generally good once you’re in. My dad had an accident and was in and out of hospital, now he has a district nurse who is brilliant.” “My wife has an ongoing medical condition and the doctor said at her last visit that if she becomes ill she must be seen by him straight away.
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